Gross v. North Dakota Department of Human Services

Summary

The Supreme Court of North Dakota affirmed a judgment upholding the Department of Human Services’ decision to place David Gross in the Medicaid lock-in program. The court held that the Department’s findings that Gross had misutilized medical services by obtaining excessive and uncoordinated care from multiple providers were supported by a preponderance of the evidence. The court also upheld the Department’s interpretation of the applicable administrative regulation and applied deferential review to the agency’s factual findings.

Holdings

1. N.D. Admin. Code § 75-02-02-11 authorizes the Department to place a Medicaid recipient in the lock-in program for excessive utilization of medical services from more than one provider when the excessive services may increase the possibility of adverse effects to the recipient's health or decrease the overall quality of care and there is little or no evidence of medical need.
2. The Department's finding that Gross misutilized medical services was supported by a preponderance of the evidence.

Questions Presented

1. Whether the Department's findings that Gross misutilized medical services were supported by a preponderance of the evidence.
2. Whether N.D. Admin. Code § 75-02-02-11 authorizes Medicaid lock-in based on excessive utilization of medical services from multiple providers when the utilization may adversely affect the recipient's health or quality of care and there is little or no evidence of medical need.
3. Whether the Department's findings supported its decision to place Gross in the Medicaid lock-in program.

Disposition

affirmed